Damage to peripheral nerves. Radial nerve and its lesions: neuralgia, neuropathy, neuritis Signs of radial nerve lesions

Pathology n. radialis on any part of it, having a different genesis (metabolic, compression, post-traumatic, ischemic). Clinically manifested by the symptom of a “dangling hand”, caused by the inability to straighten the hand and fingers; impaired sensitivity of the posterior surface of the shoulder, forearm and rear of the 3.5 first fingers; difficulty abducting the thumb; loss of the extensor ulnar and carporadial reflexes. Diagnosed mainly by neurological examination, auxiliary are: EMG, ENG, radiography and CT. The treatment algorithm is determined by the etiology of the lesion and includes etiopathogenetic, metabolic, vascular, and rehabilitation therapy.

General information

Radial neuropathy is the most common peripheral mononeuropathy and is sometimes caused by simply placing your hand incorrectly during deep sleep. The development of radiation neuropathy is often secondary and associated with muscle overload and injury, which makes this pathology relevant both for specialists in the field of neurology and for traumatologists, orthopedists, and sports physicians. Topic lesion n. radialis is reduced to three main levels: in the armpit, at the level of the middle 1/3 of the shoulder and in the area of ​​the elbow joint. Features of the location of the radial nerve at these levels will be described below.

Anatomy of the radial nerve

The radial nerve originates from the brachial plexus (C5-C8, Th1). It then passes along the back wall of the armpit, at the lower edge of which it fits tightly to the intersection of the latissimus dorsi muscle and the tendon of the long head of the triceps brachii. The first place of potential compression n is located at this level. radialis. Next, the nerve passes into the so-called. “spiral groove” - a groove located on the humerus. This groove and the heads of the triceps muscle form the brachioradial (spiral) canal, passing through which the radial nerve spirals around the humerus. The brachioradial canal is the second site of possible nerve damage. After leaving the canal, the radial nerve follows to the outer surface of the elbow joint, where it divides into deep and superficial branches. The elbow area is the third place of increased vulnerability n. radialis.

The radial nerve and its motor branches innervate the muscles responsible for extension of the forearm and hand, abduction of the thumb, extension of the proximal phalanges and supination of the hand (turning it palm up). Sensory branches provide sensory innervation to the capsule of the elbow joint, the posterior surface of the shoulder, the dorsum of the forearm, the dorsal surface of the radial edge of the hand and the first 3.5 fingers (except for their distal phalanges).

Causes of radial nerve neuropathy

The most common neuropathy of the radial nerve is caused by its compression. Often, patients who have compression of the n. radialis occurred in a dream due to incorrect hand position. Such “sleep paralysis” can occur in those suffering from alcoholism or drug addiction, in healthy individuals who fall asleep in a state of acute alcohol intoxication, in people who fall asleep soundly after hard work or lack of sleep. Compression of the radial nerve with the subsequent development of neuropathy can be caused by the application of a tourniquet to the shoulder to stop bleeding, the presence of a lipoma or fibroma at the site of the nerve, repeated and prolonged sharp bending of the elbow while running, conducting or manual labor. Compression of the nerve in the armpit is observed when using crutches (the so-called “crutch paralysis”), compression at the level of the wrist is observed when wearing handcuffs (the so-called “prisoner’s paralysis”).

Neuropathy associated with traumatic nerve damage is possible with a fracture of the humerus, injuries to the joints of the arm, dislocation of the forearm, and an isolated fracture of the head of the radius. Other factors in the development of radiation neuropathy are: bursitis, synovitis and post-traumatic arthrosis of the elbow joint, rheumatoid arthritis, epicondylitis of the elbow joint. In rare cases, the cause of neuropathy is infectious diseases (typhus, influenza, etc.) or intoxication (poisoning with alcohol substitutes, lead, etc.).

Symptoms of radial nerve neuropathy

Defeat n. radialis in the armpit manifests as a violation of the extension of the forearm, hand and proximal phalanges of the fingers, and the inability to move the thumb to the side. A “hanging” or “falling” hand is characteristic - when the arm is stretched forward, the hand on the affected side does not take a horizontal position, but hangs down. In this case, the thumb is pressed to the index finger. Supination of the forearm and hand, flexion at the elbow are weakened. The extensor ulnar reflex disappears and the carporadial reflex decreases. Patients complain of some numbness or paresthesia in the rear of the 1st, 2nd and partially third fingers. A neurological examination reveals hypoesthesia of the posterior surface of the shoulder, the back of the forearm and the first 3.5 fingers, while the sensory perception of their distal phalanges is preserved. Possible hypotrophy of the posterior group of muscles of the shoulder and forearm.

Neuropathy of the radial nerve at the level of the middle 1/3 of the shoulder (in the spiral canal) differs from the above clinical picture by the preservation of extension in the elbow joint, the presence of an extensor elbow reflex and normal skin sensitivity of the posterior surface of the shoulder.

Neuropathy of the radial nerve at the level of the lower 1/3 of the shoulder, elbow joint and upper 1/3 of the forearm is often characterized by increased pain and paresthesia on the back of the hand during work associated with bending the arm at the elbow. Pathological symptoms are observed mainly on the hand. Complete preservation of sensation in the forearm is possible.

Radiation neuropathy at the wrist level includes 2 main syndromes: Turner syndrome and radial tunnel syndrome. The first is observed with a fracture of the lower end of the beam, the second - with compression of the superficial branch n. radialis in the area of ​​the anatomical snuffbox. Characterized by numbness of the back of the hand and fingers, burning pain on the back of the thumb, which can radiate to the forearm and even the shoulder. Sensory disturbances detected during examination usually do not extend beyond the first finger.

Diagnostics

The fundamental method for diagnosing neuropathy n. radialis is a neurological examination, namely the study of the sensory sphere and the conduct of special functional tests aimed at assessing the performance and strength of the muscles innervated by the radial nerve. During the examination, the neurologist may ask the patient to stretch his arms forward and hold his hands in a horizontal position (a hanging hand on the affected side is detected); lower your arms along your body and turn your hands with your palms facing forward (impaired supination is revealed); retract your thumb; placing the palms of your hands together, spread your fingers to the sides (on the affected side, the fingers bend and slide down the healthy palm).

Functional tests and sensitivity testing help differentiate radial neuropathy from ulnar nerve neuropathy and median nerve neuropathy. In some cases, radial neuropathy resembles level CVII radicular syndrome. It should be borne in mind that the latter is also accompanied by a disorder of wrist flexion and shoulder adduction; characteristic pain of the radicular type, aggravated by sneezing and head movements. The main directions in the treatment of radiation neuropathy are: elimination of etiopathogenetic factors in the development of pathology, supportive metabolic and vascular therapy of the nerve, restoration of the function and strength of the affected muscles. Regardless of the genesis of the disease, radial nerve neuropathy requires an integrated approach to treatment.

According to indications, etiopathogenetic therapy may consist of antibiotic therapy, anti-inflammatory (ketorolac, diclofenac, ibuprofen, UHF, magnetic therapy) and anti-edematous (hydrocortisone, diprospan) treatment, detoxification by drip administration of sodium chloride and glucose solutions, compensation of endocrine disorders, reduction of dislocation, reposition of bones for a fracture, application of a fixing bandage, etc. Neuropathy of traumatic origin often requires surgical treatment: neurolysis, nerve plasty.

In order to quickly restore the nerve, metabolic (calf blood hemodialysate, Vit B1, Vit B6, thioctic acid) and vasoactive (pentoxifylline, nicotinic acid) drugs are used. For the rehabilitation of the muscles innervated by it, neostigmine is prescribed,

A beam fracture in a typical place... The expression sounds ridiculous: how can a beam be broken? Sunny, light? And if possible, where is it, is this a typical place?

But for doctors, the phrase is absolutely clear, because “ray” is an abbreviated name for the radial bone, which is served by the radial nerve.

The bones have an absolutely remarkable structure, because it ensures the activity of several joints at once: the brachioradial, two radioulnar (upper and lower) and the radiocarpal. It is somewhere near the last of the named joints that the radial fracture occurs - the lower third of the radial bone is that very “typical place”.

About the causes and risk factors

The peculiarities of the connection of the bones that make up the upper limb are, in the case of normality, the optimal option for the functioning of the radial nerve that serves it, but in the case of pathology, they become a stumbling block for their activity. For, both the narrowing of the bone-tendon (bone-fascial) tunnels and the deformations of the bones themselves become difficult to overcome, or completely insurmountable obstacles to the conduction of nervous “electricity” both up (from the limb to the brain) and down (from the brain to the place of application ).

In addition to the gradual and systematic “strangulation” of the nerve due to the development of rheumatism, arthrosis and other chronically painful conditions with the proliferation of connective tissue, there are also rapidly, acutely developing disorders that lead to compression of the nerve by swollen tissues. This happens precisely with the notorious fracture in a typical place.

But it can also be a dislocation - a displacement of a bone from its rightful place in a joint, which occurs when a bone is “pulled out” from it (with a sudden stretch of a limb: a sharp jerk when pushing out a cannonball or throwing a grenade).

Tissue swelling can also be a consequence of hard, exhausting physical labor, which makes your hands go numb.

In addition to edema caused by a violation of the biomechanics of movement, an allergic reaction to a food component or a medicinal substance can also lead to massive edema. Or it could be acute toxic swelling from the stings of several dozen bees. Or exposure to poison from a bite from other dangerous animals.

Whatever the obstacle to the path of the radial nerve - whether permanent or temporary - the result will be its reaction to negative external influences in the form of the following diseases:

• neuropathy;
• neuralgia;
• neuritis.

But the same reaction can also occur from damage to the nerve from the inside - from disorders in the capillary network that feeds the organ. Or from the presence of toxins in the blood:

• bacterial;
• viral;
• appeared as a result of household poisoning or habitual intoxication.

There is also the possibility of direct infection of the nerve (with leprosy).

Finally, direct damage to the radial nerve (its trunk or branches) is possible, both from bone fragments during a bone fracture, and from a foreign body due to combat, domestic, industrial or criminal trauma - from the introduction of a bullet, a fragment of ammunition, a bladed weapon, or a fragment of wood, glass, plastic, metal.

Anatomical and physiological certificate

For the radial nerve, which originates from the brachial plexus formed by the C5-C8, Th1 roots, the first potentially dangerous place in terms of compression is the posterior wall of the axillary cavity. This is the “crossing” of the latissimus dorsi muscle with the tendon of the long head of the triceps brachii muscle.

Then, bending around the humerus in a spiral groove (brachioradial canal - a groove on the humerus covered by the head of the triceps), it runs the risk of being crushed by a long-used crutch just as much as in the previous case.

The place where the radial nerve divides into two branches - superficial and deep - on the outer surface of the elbow joint is the third gap along the route of the nerve, where “suffocation” by compression can be expected.

The radial nerve includes sensory branches running from bottom to top that conduct sensations to the brain from:

• elbow joint capsule;
• posterior (dorsal) surface of the shoulder,
• as well as “reading” information from the back of the forearm and the radial edge of the hand with the first three and a half fingers (excluding their terminal, distal phalanges).

The motor branches of the nerve serve to bring the muscles into working condition and maintain them:

• extensor forearm and hand:
• abductor thumb
• as well as extending the proximal phalanges of the other fingers, they are also in charge of supination of the hand (turning the hand into a “begging pose” - palm up).

Such is this magnificent “cable” with communication working in both directions.

But sometimes (for the reasons mentioned above) it gets damaged.

And then the picture of the world created in the brain with its participation is distorted.

The perception of the world can become abnormal for two reasons:

1. The first one is nerve receptor damage, collecting information from the surface of the body.
2. Second - information does not pass through the damaged “wire” at all(nerve paralysis), or passes with great difficulty, losing authenticity on the way to “headquarters”.

These three levels of disturbance of perception and conduction (in increasing degree of disorder) are called:

• neuropathy;
• neuralgia;
• neuritis.

What you need to know about the radial nerve - anatomy and physiology:

Symptoms – from “goosebumps” to “insensibility”

Considering that the radial nerve extends to the hands over the entire 1st (also known as thumb), 2nd, 3rd finger and the medial half of the 4th finger, as well as the outer half of the forearm, pain of varying intensity will occur in this area. They have a varied character - from “crawling goosebumps” and “numbness” - to a feeling of “boiling water burn” and sharp pain – “to the point of fainting”.

But in addition to pain, disorders in the motor sphere also occur. Because the normal activity of the nerve structures that ensure the functioning of the muscles in this area is disrupted.

This results in the symptom of a “dangling hand” (due to the weakness of its muscles, the raised hand hangs like an empty glove); difficulties with adduction and abduction of the first finger and extension of the wrist, forearm and hand are also characteristic.

The level of sensitivity of the dorsum of the hand, the first three and a half fingers and the back of the forearm ranges from to .

The muscles that extend the hand and fingers are weak; the supinator muscle and the brachioradialis muscle are also affected; the performance of the carporadial reflex is disrupted, pain appears in the process of violent measures to supinate the forearm and straighten the fingers.

In addition, there are painful sensations during palpation in the areas where the radial nerve runs.

With a long-term condition, muscle atrophy occurs in the specified area.

This clinical picture most often occurs:

• when the radial nerve is “squeezed” during prolonged sleep in one position (due to alcohol intoxication, severe fatigue), or due to a fracture, walking on crutches;
• due to chronic alcohol or lead intoxication;
• after an infection.

How to distinguish one form of damage from another?

In a number of publications devoted to lesions of the radial nerve and especially traumatic etiology, the term “neuritis” or “neuropathy” is often used to designate the same manifestations, which introduces a certain confusion in the perception of information.

This happens because there is no clear boundary between these concepts, just as there is no clear boundary of the threshold of perception - sensitivity in patients with this pathology.

Neuritis is an inflammatory-degenerative process in the trunk or branches of the radial nerve (in contrast to neuralgia - pain along the nerve, either occurring spontaneously or “awakened” by palpation or movements).

Strictly speaking, neuropathy is considered a pathology that does not have an anatomical substrate, caused largely by a general disorder of the nervous system in an overly impressionable individual who has some peculiarities of perception of the world - in a hysterical or neurotic personality. Individuals who already consider the appearance of “goose bumps” from cold or fear to be a disease.

In such a case, they talk about neuropathy - a case when there is no disease. But there is “pre-pathology” - increased susceptibility to sensations or exaggerated attention to the manifestations of the activity of one’s body.

What gives rise to a neurotic’s assumption that he has a painful condition. In support of this, he cites many symptoms and sensations that do not have any serious material basis, which is confirmed by repeated studies.

Neuropathy in terms of sensations in the upper limb has the same basis as either. A neurotic person or someone suffering from painfully close attention finds varying degrees of painful sensations in different parts of the body.

And in the advanced version, loss of sensitivity and even movement disorders simulated by the state of his nervous system may appear.

In contrast to true pathology, they disappear without a trace after the end of a hysterical attack. Or – when the patient’s attention switches to manifestations of a new pathology discovered in himself, replacing yesterday’s ones.

Treatment of this pathology is similar to measures to combat hysteria.

There is also such a form of radiation neuropathy as “prisoner” - or “shackled” - “paralysis” that occurs when wearing shackles. This is a lesion of the radial nerve at the carpal level, including the development of either radial tunnel syndrome or Turner syndrome.

The first option develops due to compression of the nerve (its superficial branch) in the “anatomical snuffbox”, the second is a consequence of a fracture of the ray in a typical place. Both syndromes are manifested by “numbness” of the back of the fingers and the entire hand, burning pain of the back of the first finger, radiating to both the forearm and shoulder. Moreover, sensory impairments are limited to the thumb (I) finger.

Neuralgic lesion

Neuralgia of the radial nerve is characterized by exclusively sensitive disorders (paroxysmal intense pain strictly in the zone of its extension) with the absence of loss of sensitivity and motor disorders. There are no changes in the structure of the affected nerve.

A feature of neuralgic pathology is a clear connection between the pathology of the nerve and the need for it to pass through narrow natural anatomical openings and canals and the existence of trigger areas, the palpation of which naturally provokes pain.

Neuritis and its manifestations

The extreme severity of neuritis of the radial nerve - with damage to its main trunk in the region of the spiral canal - “crutch paralysis” - is characterized by loss of all functions of the nerve as an organ (in case of more distal damage, the disturbances are only partial and depend on the severity of the damage to its fibers).

The clinic is characterized by:

Hypotrophic disorders in the posterior group of muscles of the forearm and shoulder are also common with:

• point pressure on the nerve in the middle third of the outer region of the shoulder (pressure on the nerve with the head during the “Saturday night” or “park bench” syndrome);
• unsuccessful injection (injection form of neuritis);
• in case of chronic lead intoxication, the picture is similar to that described above with the difference that the extensor elbow reflex and the norm in skin perception for the posterior humeral surface are preserved.

Overload of the muscles surrounding the elbow joint leads to the formation of “tennis elbow” (with the development of myofasciopathies and excess perineural tissue).

With this type of lesion, the prerequisites are created for hypotrophy, weakness and pain in the extensors of the forearm, pain during forcibly active extension of the fingers - strengthening and pain in the back of the hand at work, as well as intense pain in the upper third of the forearm and in the elbow. At the same time, the sensitivity of the skin of the forearm on the hand can be completely preserved.

The neurologist approves and confirms

To clarify the diagnosis and establish the cause and “floor” of damage to the radial (radial) nerve - in addition to consulting a neurologist - a certain minimum of research is required, including the use of:

• radiography;
• computed tomography the area of ​​the elbow, or wrist joint, or both joints;
• electromyography;
• electroneurography.

In order to determine disorders of the biomechanics of movements, it will be valuable to participate in the diagnostic process of a traumatologist, and to create a rehabilitation program for bone pathology - an orthopedist.

If necessary, the hormonal status is clarified and studies excluding collagenosis are carried out with the involvement of an endocrinologist and rheumatologist, as well as a blood test for sugar levels and its biochemical state.

Therapy methods

Therapy for “radiation disorders” depends on the cause of the pathology.

For chronically ongoing infectious processes, antibacterial and antiseptic agents are used. If the fracture that led to neuritis is caused by diabetes mellitus, the hormonal levels are corrected.

But the main means of treating lesions of the radial nerve will be the use of methods of rehabilitation, vascular and metabolic therapy in combination with exercise therapy, physiotherapy, massage and manual techniques.

The first echelon of medical care for neuralgia and neuritis of the radial nerve is followed by drugs with non-steroidal anti-inflammatory action (Ketoprofen, Voltaren, Naproxen) in conjunction with other anti-inflammatory drugs and analgesics (up to novocaine and hydrocortisone blockades), and to create rest for the suffering limb, immobilization in physiological position

The use of tissue preparations, vitamins and means for improving microcirculation (Milgamma, Aloe), as well as the acetylcholinesterase inhibitor – Proserin, will help stimulate the regeneration of nervous tissue, prevent disturbances in muscle trophism and maintain their tone.

A good healing and restorative effect in limb movements is achieved by the use of massage and therapeutic exercises (including in water), various methods of physiotherapy (magnetic therapy, UHF), etc.

If necessary, surgical methods are also used to restore the condition of the radial nerve - plastic surgery in the form of:

• neurolysis– excision of epineural scar tissue compressing the nerve;
• epineural suture– plastic surgery of the damaged nerve using grafts that allow suturing its ends.

Damage to the radial nerve can cause persistent dysfunction of the limb in the form of paralysis, paresis, contractures, which can lead to disability due to loss of ability to work, and, if it develops bilaterally, to self-care.

On the issue of prevention

The main measure to prevent damage to the radial nerve is the prevention of injuries to the upper extremities in the form of avoiding excessive stress on the bones and muscles. But a complete lack of training leads to uncertainty when walking and moving and guarantees injury.

Avoidance of habitual household intoxications, adherence to routine and rest standards, and participation in active games and dancing also lead to injury prevention.

Treatment of chronic diseases of any origin also helps prevent these sad consequences. Seeking medical help for any health problem should be the norm of behavior for a modern person.

RADIAL NERVE [nervus radialis(PNA, JNA, BNA)] is a long nerve of the brachial plexus, innervating the dorsal muscles of the upper limb, the skin of the posterolateral surface of the lower half of the shoulder, forearm and hand.

Anatomy

RADIAL NERVE (color fig. 1-3) starts from the posterior bundle of the brachial plexus (fasc. post, plexus brachialis). Contains nerve fibers most often from segments C5-8, less often from C5-Th1 or C5-7, which are sent to the L. n. as part of all three trunks of the brachial plexus (trunci plexus brachialis), mainly as part of the upper trunk, to a lesser extent - the middle and lower. From the posterior fascicle of the brachial plexus of the L. n. usually departs within the axillary cavity (cavum axillare) at the level of the pectoralis minor muscle behind the axillary artery. In the axillary cavity L. n. is the thickest nerve of the brachial plexus (see). However, after the departure of the muscle branches already at the level of the middle of the shoulder, it becomes thinner and includes fibers mainly only for the forearm and hand. At the level of the upper third of the shoulder, the diameter of the left n. is 3.4-4.6 mm. The largest number of bundles (up to 52, on average 24-28 bundles) is contained in the nerve in the axillary cavity, the smallest (minimum 2, on average 8 bundles) is at the level of the middle of the shoulder. The initial part of the nerve contains up to 22 thousand pulpy nerve fibers and 6-8 thousand non-pulpate ones, in the middle third of the shoulder - 12-15 thousand and 2.5-5 thousand, respectively. Among the pulpy fibers, the diameter is 1 - 3 microns (small) make up 3-11%, 3.1-5 microns (medium) -8-12%, 5.1 - 10 microns (large) - 70-86%, St. 10 microns (very large) - up to 14%. On the shoulder of L. n. located next to the deep artery of the shoulder in the posterior osteofascial space in the brachiomuscular canal (canalis humeromuscularis). Then, perforating the lateral intermuscular septum, it passes into the lateral anterior ulnar groove, where it is located between the brachioradialis muscle - laterally and the brachialis - medially. In the upper part of the named groove in front of the head of the radius, L. n. is divided into two terminal branches: superficial and deep.

L.n. gives off the following branches: 1) articular branch (g. articularis) - to the capsule of the shoulder joint; 2) posterior cutaneous nerve of the shoulder (n. cutaneus brachii post.) - to the skin of the back of the shoulder; this branch usually originates in the axillary cavity, passes over the long head of the triceps brachii muscle, penetrating the brachial fascia below the insertion of the deltoid muscle, and branches in the skin of the lateral posterior surface of the lower half of the shoulder; 3) lower lateral, cutaneous nerve of the shoulder (n. cutaneus brachii lat. inf.), formed below the previous one, running next to it and branching in the skin of the lateral surface of the lower third of the shoulder; 4) muscular branches (rr. musculares), among which the proximal ones are distinguished, separating from the L. ii. in the axillary cavity to the long, lateral and medial heads of the triceps muscle, to the olecranon muscle, and distal, extending from the L. n. in the depth of the groove between the brachioradialis and brachialis muscles to the lateral part of the brachialis muscle, to the brachioradialis muscle (this branch sends a thin branch to the capsule of the elbow joint), to the long and short extensor radialis of the hand; 5) posterior cutaneous nerve of the forearm (n. cutaneus antebrachii post.), formed within the brachiomuscular canal, piercing the brachial fascia in the interval between the lateral and medial heads of the triceps muscle, emerging, accompanied by the radial collateral artery, dorsally from the lateral epicondyle of the humerus to the dorsal surface of the forearm , giving off multiple branches to the skin; 6) superficial branch (g. superficialis), which arises as a terminal branch on the flexor surface of the brachioradialis joint and spreads in the radial groove of the forearm under the brachioradialis muscle. In the lower third of the forearm it passes under the tendon of the brachioradialis muscle to the back of the hand, where it is divided into the dorsal digital nerves (nn. digitales dorsales) for the skin of the back of the hand, fingers I and II, the radial side of the third finger (proximal phalanges); 7) a deep branch (r. profundus), passing through the instep, surrounding the neck of the radius, emerging on the back of the forearm, where it is divided into numerous muscle branches (rr. musculares) to the extensor muscles. The continuation of the deep branch is the posterior interosseous nerve (n. interosseus post.), innervating the long muscle, abductor pollicis, short and long extensor pollicis, extensor of the index finger; it gives off a branch to the capsule of the wrist joint.

L.n. forms connections with neighboring nerves. Among them, the most important are between the branches of the radial and axillary nerves, between the superficial branch of the L. n. and the lateral cutaneous nerve of the forearm, as well as the dorsal branch of the ulnar nerve (see). There are differences in the length of the zone of innervation of the cutaneous branches of the L. n. So, for example, on the back of the hand, in some cases the dorsal digital nerves innervate the skin of only the 1st and 2nd fingers, and in others - the 1st, 2nd, 3rd, 4th and radial surfaces of the 5th finger.

Pathology

L.n. is most often affected by wounds and fractures of the shoulder, less often the forearm, with intoxication (lead, alcohol), with compression of the nerve during sleep, especially during intoxication (sleep paralysis, drunken paralysis), when walking on crutches (crutch paralysis), with prolonged fixation hands to the operating table during anesthesia, as well as during prolonged compression with hooks during surgery. Pathology L. n. may also be caused by a tumor emanating from the surrounding tissues and compressing the nerve, or a neuroma (schwannoma, neurofibroma). Malignant tumors of L. n. are rarely observed. When L. is affected. in the shoulder area, the function of the extensors of the shoulder, forearm and hand is lost; the forearm is bent in relation to the shoulder, the hand droops, and the fingers are in a semi-bent state (Fig. 1). Sensitivity disorders with lesions of L. n. (Fig. 2) are noted on the dorsum of the shoulder, forearm, on the dorsum of the radial half of the hand, on the proximal and middle phalanges of the first, second and partially third fingers. Due to connections with other nerves, these disorders have a much smaller area of ​​cutaneous innervation.

When L. is affected. in the middle and lower third of the shoulder and upper third of the forearm, the function of the triceps muscle is preserved, paralysis of the extensor digitorum of only the proximal phalanges is noted, and the extension of the middle and distal phalanges is partially preserved due to the function of the interosseous muscles. Depending on the location of the injury, the reflex from the triceps muscle may fall out. When the nerve in the area of ​​the wrist joint is damaged, its terminal branch, which contains many autonomic fibers, is affected, resulting in swelling, coldness and blue discoloration of the dorsum of the hand; pain is extremely rare.

With paralysis of the wrist extensors, the function of the flexors may also suffer, which often leads to incorrect diagnosis of simultaneous damage to the median and ulnar nerve, so the use of tests to help clarify the diagnosis is very important.

The main tests used to diagnose L. n. lesions: 1) both hands approach each other with their palms so that all fingers of the same name come into contact; when the fingers of the healthy hand move away from the fingers of the patient, palmar flexion of the fingers is noted on the side of the affected nerve; 2) when asked to shake the doctor’s hand or form a fist, the flexion position of the drooping hand increases.

Lesions of L. n. can be primary (as a result of injury, tumor) and secondary (when the nerve is involved in scars, compressed by tumors, a plaster cast due to swelling of soft tissues). There are isolated and combined injuries (together with blood vessels and bone).

The symptoms of the lesion are determined by the nature and level of the pathol, the process, depending on which motor and sensory disorders manifest themselves to a greater or lesser extent.

The order of sequential restoration of muscle function during L. n. regeneration. next: extensors of the hand, general extensors of the fingers, long muscle, abductor pollicis and supinator.

Treatment of lesions of L. n. determined by the nature of the patol, the impact (trauma, intoxication, ischemia, allergy). Conservative treatment is aimed at stimulating nerve regeneration and eliminating pain. Dehydrating, desensitizing agents, vitamins, calcium preparations, ATP, lidase, nicotinic acid, complamin, nikoshpan, analgesics (analgin, butadione, reopirin, brufen, etc.), and in some cases acupuncture are used. Physiotherapy (thermal procedures, novocaine electrophoresis, UV erythema therapy), exercise therapy, and massage are prescribed.

Operations are indicated for wedge, nerve rupture, tumors, nerve compression, pain syndrome. For wounds, there are primary (together with surgical treatment of the wound), delayed (in the first weeks) and late (3 months after the wound) operations. In case of combined damage to the nerve and bone, one-stage and two-stage operations are performed. The latter are indicated in cases of impossibility of qualified restoration of the anatomical integrity of the nerve during the first operation, in the presence of an infected bone fracture. The phasing of interventions for combined injuries consists of preparing the nerve for plastic surgery and osteosynthesis, followed by neurorrhaphy (see Nerve suture). Access to the nerve during operations is shown in Figure 3.

The operation is effective with early, atraumatic, radical intervention. They perform neurolysis (see), tumor removal, nerve neuroma, neurorrhaphy, nerve autoplasty. Nerve grafting with preserved nerves is ineffective. The condition for successful neurorrhaphy is that the intervention is atraumatic, the fibers of the central and peripheral ends of the nerve are accurately compared without tension, and individual bundles are sutured using micro-neurosurgical techniques. Benign tumors of L. n. (neurinoma-schwannoma, neurofibroma) are subject to removal in case of pain and increasing symptoms of loss of nerve function. In case of malignancy of the tumor, the operation is aimed at its removal with resection of the nerve and extended excision of surrounding tissue to prevent metastasis. Subsequent radiation and chemotherapy complete the treatment. Sometimes radiation treatment is given before surgery.

Bibliography: Atlas of the peripheral nervous and venous systems, ed. V. N. Shevku-nenko, p. 47, L., 1949; Blinov B.V., Bystritsky M.I. and P about p about in I.F. Rehabilitation of patients with fractures of the diaphysis of the humerus and damage to the radial nerve, Vestn, hir., t. 115, No. 8, p. 96, 1975; Intra-trunk structure of peripheral nerves, ed. A. N. Maksimenkova, L., 1963, bibliogr.; Voiculescu V. and Popescu F. Progressive non-traumatic palsy of the deep branch of the radial nerve, Romanian, med. review, no. 4, p. 55, 1969; Grigorovich K. A. Nerve surgery, L., 1969, bibliogr.; Kalnberz V.K., Lishnevsky S.M. and Filippova R.P. Muscle plasticity in radial nerve palsy, Proceedings of Rizhsk. scientific research, Institute of Traumatology, and Orthopedics, vol. 10, p. 189, 1971, bibliogr.; Karchi-k I N S.I. Traumatic lesions of peripheral nerves, L., 1962, bibliogr.; Kovanov V.V. and Travin A.A. Surgical anatomy of the upper extremities, M., 1965; Experience of Soviet medicine in the Great Patriotic War, 1941 - 1945, vol. 20, p. 68, M., 1952; O s i n a M. I. Errors and complications in the treatment of injuries of the radial nerve combined with a fracture of the shoulder, in the book: Relevant. Issues, trauma, and orthotics, ed. M. V. Volkova, V. 3, p. 27, M., 1971; Khoroshko V.N. Injuries of peripheral limbs and their physiotherapy, M., 1946; C 1 a g a M. Das Nervensys-tem des Menschen, Lpz., 1959.

D. G. Schaefer; S. S. Mikhailov (an.), V. S. Mikhailovsky (neurosurgeon).

One of the common neurological diseases of the upper extremities is radial neuritis.

This nerve runs through the entire arm, originating just above the shoulder joint and ending in the first three fingers of the hand.

He is responsible for turning the hand with the palm up (supination), extension of the elbow and hand, and abduction of the first finger from the rest.

Due to the proximity of the radial nerve to the skin and the peculiarities of its anatomical structure, almost all people are familiar with some of the signs of this disease. For example, everyone knows the condition “overlying the hand” - numbness of the hand after prolonged squeezing during sleep. In a healthy person, this unpleasant symptom goes away within a few minutes, but in a sick person it will bother him for a long time.

The neurological disease in question can appear for several reasons:

1. Infectious or inflammatory disease: influenza, typhus, pneumonia, measles, tuberculosis, herpes, rheumatoid arthritis. The basis of radial nerve neuritis is the inflammatory process that affects this nerve. In other words, bacteria and viruses act as causative agents of neuritis in this case.
2. Traumatic damage to the radial nerve: fracture of the humerus or radius, dislocation of the shoulder or forearm, injuries to the ligaments and tendons of the arm joints, unsuccessful injection.
3. Poisoning of the body with arsenic, lead, mercury, alcoholic beverages or other toxic substances.
4. Compression (squeezing the nerve) is the most common cause of neuritis. Occurs during sleep due to an uncomfortable position of the arm (sleep paralysis), as well as when a tourniquet is applied to the arm to stop bleeding. The radial nerve may be compressed by the tumor. When using crutches, “crutch paralysis” is sometimes observed - compression of the nerve in the armpit. Prisoners experience "prisoner's paralysis" - compression of the radial nerve in the wrist area.
5. Excessive overload of one of the muscles innervated by the radial nerve.

Some diseases can cause hearing problems. if prolonged and left untreated, it can lead to deafness.

Symptoms and treatment methods for facial neuritis are described.

Types of radial neuritis

According to the mechanism of traumatic effect on the radial nerve, all neuritis of the radial nerve can be divided into three types:

1. Axillary neuritis, or “crutch paralysis.” It is less common than other types and is characterized by weakness of the function of the forearm flexors and paralysis of its extensors.
2. Damage to the radial nerve in the area of ​​the middle third of the shoulder, on its outer posterior surface. It is quite common and is usually the result of a fracture, improper injection, or sleeping in an awkward position. Also, neuritis of this type can act as a complication of an infectious disease.
3. "Tennis Player Syndrome"– damage to the posterior branch of the radial nerve in the area of ​​the elbow; mainly occurs due to overload of the muscles of the elbow area, which can often be observed in tennis players. Dystrophic changes in the ligaments and tendons of the elbow joint lead to chronic disease of the radial nerve. It is manifested by pain and weakness in the muscles of the forearm, pain when rotating the hand and when moving the fingers.

Radial nerve location

Symptoms

The pathology expressed by radial nerve neuritis disrupts the normal motor functions of the hand, changes the microstructure of its nerve fibers and reduces sensitivity.

Most often, the disease manifests itself as a symptom of a “dangling hand” on an arm raised forward or upward. Pain is felt along the affected nerve trunk.

The symptoms of this disease are varied and depend on the location and type of pathological process:

1. Wrist and lower forearm area: Characterized by burning pain on the back of the first finger, radiating to the forearm and higher into the shoulder, as well as loss of sensitivity in the skin of the fingers and the back of the hand. Impaired abduction of the thumb. The patient cannot clench his fist painlessly.
2. Elbow, upper forearm or lower third of the shoulder: Sensitivity on the back of the hand decreases, it becomes impossible to straighten the fingers and hand. Pain on the back of the hand intensifies during activities in which the arm is bent at the elbow. The sensitivity of the skin of the forearm is practically not impaired.
3. Upper or middle third of the shoulder and armpit: impossibility of abducting the thumb; only with great difficulty can one bend the arm at the elbow. Weakness and decreased sensitivity of the thumb, index and half of the middle finger, as well as the back of the shoulder. If the patient stretches both hands in front of him, then he cannot turn the sore hand with the palm up, the thumb is pulled towards the index finger, and the hand on the sore side hangs down. If the middle third of the shoulder is affected, the extension of the forearm is not impaired, the sensitivity of the skin of the back of the shoulder is preserved.

In any case of the disease, radial neuritis will be manifested by pain along the nerve, muscle weakness and decreased sensitivity (numbness) in the hand.

Diagnostics

To verify the presence of this pathology, several functional tests are performed during a neurological examination to identify impairments in the motor function of the hand. The following signs clearly indicate radial nerve neuritis:

• if the patient presses both palms to each other and tries to spread his fingers, then on the sore hand the fingers will bend and slide along the palm of the healthy hand;
• with the sore hand lying on the table, palm down, a person will not be able to place its middle finger on the ring or index finger;
• in a standing position with arms down along the body, the patient will not be able to turn the hand forward with the palm on the affected side and move the thumb up;
• When the hands are positioned with the back of the hands lying on the table, the person is unable to abduct the thumb.

Treatment of neuritis of the radial nerve of the hand

When treating this neuritis, the cause of the disease must be taken into account. So, for neuritis caused by bacteria and viruses, drug treatment should be prescribed with the active use of antibiotics and decongestants.

If the disease arose under the influence of external factors, such as sleeping in an uncomfortable position, playing intense tennis or using crutches, then these factors must be eliminated during treatment.

Neuritis caused by muscle atrophy is treated simultaneously with the underlying disease.

If the disease is a consequence of injury, then in addition to anti-inflammatory drugs, immobility of the injured limb is ensured. If conservative therapy is ineffective, surgical intervention is used to restore the injured radial nerve.

To eliminate painful sensations, restore sensitivity and increase muscle tone, physiotherapeutic procedures are prescribed:

• electrophoresis with drugs;
• electromyostimulation;
• ultrasound with hydrocortisone;
• acupuncture;
• magnetic therapy;
• ozokerite.

Vascular preparations are widely used together with vitamin complexes; they help restore normal blood circulation in the sore arm.

Treatment of radial neuritis cannot be complete without physical therapy and massage.

Most rehabilitation exercises are performed using spring and rubber machines to work the joints. Exercises in water are also effective and beneficial.

Therapeutic measures are selected for each patient individually, depending on the symptoms and cause of the disease. Treatment is usually long and requires persistence and patience from the patient.

Leg cramps can occur due to heavy loads, as well as insufficient intake of minerals from food. — review of traditional and folk methods.

At a young age, neuritis responds well to treatment and ends with complete recovery. However, in older people, especially in the presence of concomitant diseases and lack of treatment, limb paralysis and the formation of contractures may occur.

In this regard, in order to avoid irreparable consequences, it is necessary to seek medical help at the first signs of the disease.

Video on the topic

Radial neuralgia is a disorder of innervation in any part of the right or left arm. The nature of the occurrence of reduced sensitivity of the nerve roots can be different, however, the degree of danger is always high. Thus, in the absence of complete and adequate treatment, sensory impairment becomes irreversible, leading patients to disability.

Causes of the disease

Radial neuralgia can be of various origins: post-traumatic, metabolic, compression or ischemic origin. The main reason is prolonged compression on a certain area of ​​the arm. Compression can be caused by the following factors:

• sleeping in an uncomfortable position with severe fatigue, alcohol intoxication (the patient rested his arm);
• brain pathologies;
• formation of scar tissue between muscles after injury;
• humerus fractures;
• prolonged squeezing with a tourniquet;
• injections into the outer brachial region, especially in the presence of anatomy of nerve localization;
• pressure on the arm due to crutches.

It can develop against the background of lead poisoning, acute intoxication with alcohol, food, poisons, and diabetes. Innervation often occurs during pregnancy, hormonal disorders, and acute inflammatory diseases of any nature.

Symptoms

The symptom complex directly depends on the localization of compression and the degree of compression of the nerve roots. Considering that the degree of compression of nerves has several types, the symptoms are also expressed in accordance with the type of pathology.

Type 1 severity

Nerve tissue damage usually occurs in the armpits on the right or left. The following symptoms are identified:

• with the arm in a straight position, extension of the hand is difficult;
• when the arm is raised, there is a drooping of the hand;
• numbness, tingling, paresthesia in the distal parts;
• impaired elbow reflex;
• partial numbness.

Type 2 severity

The lesion occurs as a result of prolonged compression of the arm during sleep, fixation during injuries, or improper application of a tourniquet. The symptoms are as follows:

• the forearm is mobile, extends, sensitive, the reflex is preserved;
• loss of sensitivity of the hand on the inside;
• constant goosebumps on the back of the hand;
• violation of extension of fingers and hands.

Type 3 severity

This type of compression is often caused by post-traumatic factors, and the symptoms are expressed by the following manifestations:

• pain with any physical activity;
• pain when straightening fingers;
• weakness and hypotrophy of the extensor muscles of the forearm.

Any movement with type 3 compression is accompanied by pain. Clinical manifestations vary in intensity, which is associated with multiple factors.

To identify diseases, differential diagnosis is carried out to exclude inflammation of the radial nerve and neuritis.

Diagnosis and treatment

The main diagnostic goal is to establish the sensory sphere and conduct functional tests that reliably determine the ability of the muscle structures innervated by the radial nerve. An important aspect is the neurological examination. The neurologist performs several tests:

• straightening and raising your arms;
• rotation, extension of the hands;
• finger mobility.

At the time of such actions, the patient’s reaction to the actions performed is assessed. Based on the data obtained, one disease is differentiated from another. Among instrumental diagnostic methods, X-ray is important.

The diagnosis is based on the patient’s clinical history. If it is severe, consultation with a cardiologist, endocrinologist, or therapist may be required.

Treatment tactics

Treatment of pathology is usually carried out at home. The treatment process necessarily includes a number of the following activities:

• drug course of therapy (antibiotics, vasodilators, anti-inflammatory drugs,);
• vitamin complexes to improve general and peripheral blood circulation (capsules and tablets or injections);
• physiotherapeutic procedures to relieve pain and increase muscle tone.

Post-traumatic disruption of innervation requires immobilization of the limb, drug treatment and elimination of the consequences of atrophy. During treatment, a course of massage, electrophoresis, physical therapy and special exercises is required. Use traditional treatment methods at home without a doctor’s advice.

Radial neuralgia is a serious disease that requires immediate correction. Lack of therapy often causes irreversible changes in the general and peripheral system.